Organization
PENN MEDICINE-PMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTE JACKSON (PAYER SUPERVISOR)
(267) 207-7303
Entity
Organization
Contact information
Practice address
2650 EGYPT RD, AUDUBON, PA 19403-2302
(215) 662-6187
Mailing address
150 MONUMENT RD, BALA CYNWYD, PA 19004-1702
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Enumeration date
05/24/2021
Last updated
02/04/2022
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